Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CMS > Salivary gland diseases > Flashcards

Salivary gland diseases Flashcards

1
Q

How do you examine salivary glands? (2)

A
  • Visually - front, side and behind pt
  • Palpate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which nervous pathway increases salivary flow?
Which decreases salivary flow?

A

Incr = Parasympathetic - cholinergic

Decr = Sympathetic - adrenergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What CN innervates submandibular and sublingual gland? Incr salivary flow?

A

CN7 - facial nerve, chorda tympani

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What CN innervates parotid gland? Incr salivary flow?

A

CN9, glossopharyngeal - lesser petrosal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What CN innervates minor salivary glands? Incr salivary flow?

A

Both CN7 and CN9 - facial nerve and glossopharyngeal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does the sympathetic, adrenergic pathway work? To decr salivary flow? (5)

A
  • Sympathetic outflow
  • Cervical ganglia
  • Plexus along artery walls
  • Branches to CNs
  • Innervates salivary glands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does saliva contain?

A

99.4% water
0.6% minerals and proteins

  • Inorganic = sodium, potassium, chloride, bicarbonate, hydrogen, iodine, fluoride, calcium phosphate
  • Organic = urea, uric acid, AAs, glucose, lactate, fatty acids
  • Macromolecules = serum proteins, glycoproteins, peroxidases, amylase, lysozymes, IgA, IgG, IgM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the flow rate of saliva stimulated and non stimulated?

A

Stimulated = 4 - 5 ml/min
Non stimulated = 0.3 - 0.4 ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can you investigate salivary gland disease? (7)

A
  • Sialomertry
  • Oral rinse
  • Plain film radiography
  • Ultrasound
  • Bloods
  • MRI
  • Biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is Sialometry used?

A
  • Measure of saliva produced ml/min over 5-10mins
  • Crude technique, not used in practice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is plain film radiography used?

A
  • Identifies radio opaque calculus
  • Needs 2 radiographs at 90 degrees to each other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is Ultrasound used?

A
  • High freq sound waves can identify solid lesions incl. tumours / calculus / cysts
  • Not good for assessing salivary gland function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is Sialography used?

A
  • Retrograde sialography examines ductal system using radio iodide
  • Shows structures, filling defects
  • Not good for investigating salivary tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are bloods used?

A
  • Venous blood sample for xerostomia pt
  • Sjogren’s screen involves - FBC, liver function tests, urea, electrolytes, HbA1C (glucose test), serum immunoglobulins, hep C and HIV serology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Sjogren’s syndrome?

A
  • Autoimmune disease affecting exocrine glands
  • Effects moisture production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is MRI used?

A
  • Magnetic Resonance Imaging
  • Demonstrates soft tissue detail
  • Ideal to see tumour extent and relation to normal anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How are biopsies used?

A

Excisional for minor SGs - done IO
Incisional for major SGs - done IO / EO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are symptoms of salivary gland diseases?

A
  • Swellings - localised / generalised / uni / bi-lateral / persistent / transient
  • Pain
  • Discharge from SG duct
  • Xerostomia / Sialorrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 11 salivary gland diseases need to know?

A
  • Obstructive
  • Xerostomia
  • Sialorrhoea
  • Sarcoidoisis / HIV related SG disease
  • Cancers
  • Benign neoplasias
  • Benign cysts
  • Acute / chronic sialadenitis
  • Frey’s syndrome
  • Developmental abnormalities
  • Primary / secondary Sjogren’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are main causes of obstructive SG disease?

A
  • Calculi
  • Strictures (narrowing of duct)
  • Infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define sialadenitis?
How is it categorised?

A

Inflammation of salivary gland
Infective
Obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What else may cause obstructions of salivary glands?

A
  • Local swellings e.g. from cancers / lymph nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe salivary gland calculi

A
  • AKA Sialoliths
  • Most common cause of obstructive sialadenitis
  • Usually major salivary glands
  • Hard
  • Single / multiple
  • 80% involve submandibular gland
  • Can be asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What causes strictures?

A

Trauma to the duct followed by fibrosis
Nearly all acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How common are strictures?
Less common than calculi / mucus plugs
26
How can localised strictures be treated?
Balloon dilation But future re-stenosis may occur
27
What causes an acute obstruction and how is it described? How does it resolve?
Calculus / mucus plug Recurrent, before eating, painful swelling of major SG AKA mealtime syndrome Resolves within 30 mins
28
How to manage calculi?
- If asymptomatic - leave - If symptomatic and small can remove by incising to release stone - If symptomatic and large can retrieve endoscopically or remove whole gland
29
What are some of the associated risks when removing submandibular gland?
- Damage to marginal mandibular nerve - Damage to lingual nerve - Damage to hypoglossal nerve
30
What are some of the associated risks removing parotid gland?
- Damage to facial nerve, lading to unilateral facial weakness - Frey's syndrome
31
What is the difference between hypo salivation and xerostomia?
Xerostomia = perception of dry mouth - subjective Hyposalivation = reduced saliva production - objective
32
What can cause xerostomia? (9)
- Medx - Diabetes - Anxiety - Mouth breathing - Dehydration - Irradiation to salivary glands - Acute infections - Recreational drug use - Sjogren's syndrome
33
Which mechanisms cause drugs to suppress saliva production?
Central effects to brain Anti-muscarinic effects Sympathomimtrics (stimulate sympathetic nerves)
34
Name some prescribed drug groups which cause xerostomia
- Tricyclic depressants - MAOIs - Antihistamines - Diuretics - Antipsychotics - Antiparkinsonian
35
GDP level how can you manage xerostomia (11)
Smoking cessation Alcohol cessation Advise increase H20 intake Avoid caffeinated drinks Sugar free gum Dietary advice to avoid cariogenic foods F- intake through toothpaste / mouthwash / FVA Increase freq of dental check ups Discourage mouth breathers Treat oral candidoses Prescribe saliva substitute
36
Why aren't saliva substitutes / oral lubricants suitable for all pts? (3 examples)
- Glandosane = acidic can cause erosion, so only suited to edentulous pts - BioXtra = made of cow's milk, pt dietary preferences (unsuitable for vegans or lactose intolerant) - Saliva Orthana = made of porcine proteins, unsuitable for Muslim and Jewish pt
37
What is Sialorrhoea and what is it also known as?
- Ptyalism - Hypersalivation Excessive production of saliva
38
What can cause Sialorrhoea?
Parkinson's Cerebral Palsy Acute viral infection Rabies Pregnancy Teething New dentures / orthodontist appliance Pancreatitis Mercury / Copper / Arsenic poisoning Side effects of drugs
39
How can Sialorrhoea be managed? (3)
Anti-muscarinics Botox Surigcally excising the gland
40
How does Botox manage Sialorrhoea?
Injected into the salivary gland Reduce ACh release Inhibiting salivation
41
What are the side effects of anti-muscarinics?
Can be worse than hypersalivation itself - Urinary retention - Constipation - Overheating due to inhibited sweating
42
What is sarcoidosis / HIV related salivary gland disease?
Chronic, multi-system, non-caseating granulomatous inflammatory disease of unknown cause
43
What is sarcoidosis characterised by?
Enlarged lymph nodes across many parts of the body
44
What can sarcoidosis / HIV related salivary gland disease cause?
SG swelling Bilateral of parotids Xerostomia
45
What does HIV SG disease involve?
- Uni/bilateral parotid gland swelling - Can cause cystic changes in SGs
46
What is graft versus host disease a consequence of? How does it happen?
Transplants e.g. bone marrow transplant Lymphocytes from the donor recognise recipient cells are foreign - so graft attacks the host
47
What can be commonly seen in GvHD?
Xerostomia Oral lichenoid lesions Generalised mucosal inflammation Candidoses Oral hairy leukoplakia
48
What are the 2 categories of SG cancers? Give examples
Benign neoplasms - pleomorphic adenomas, Warthin's tumour Malignant neoplasms - lymphoid, mucoepidermoid (common in parotid), adenoid cystic carcinomas (common in submandibular gland)
49
Radiotherapy may be used for primary / secondary malignancies - which cells are most susceptible?
Serous cells > mucus cells
50
What is glandular tissue replaced by following irradiation?
Reparative fibrosis
51
What happens to saliva following radiotherapy?
Saliva production decreases and becomes thick with altered biochemistry and properties
52
What are most benign neoplasias and which SG are they mostly found in?
Pleomorphic adenoma - 80% Parotid gland
53
Describe pleomorphic adenoma
Poorly encapsulated Slowly enlarge over many years Rarely become malignant
54
How common are Warthin's tumours? Describe and how are they managed?
Less common than PAs Well encapsulated compared to PAs so surgical excision easier
55
What is a mucocele an example of?
Benign cyst of minor SG (Dilatation and accumulation of mucus)
56
What is the main pt complaint with benign cysts?
Annoying and unaesthetic Present as recurrent / persistent swellings in lower lip / buccal mucosa
57
What does a mucocele in the upper lip suggest?
SG neoplasia - advise excision biopsy
58
What is a ranula?
Sialocyst in FoM from sublingual SG Type of mucocele Unilateral Raises tongue (Frog like appearance)
59
How is a ranula managed?
Marsupialisation - surgically cutting slit into cyst and suturing edges Excision - rare
60
What is Sialadentiis and what's its origin?
Inflammation of SGs - acute or chronic Viral origin - Mumps, CMV, HIV Bacterial origin - Streptococcal or staphylococcus infection
61
Which SG is acute sialadentis mostly seen?
Parotid
62
Which SG is chronic sialadentis mostly seen?
Submandibular
63
Signs of acute bacterial sialadentis
- Parotid - Systemically unwell - Signs of acute inflammation - Pus drains into mouth - Foul taste - Erythema, heat and swelling EO (anterior to ears)
64
How is acute bacterial sialadentis managed?
- Acute symptoms need to be managed - ABX - Hydration and antipyretics - OHI to reduce reinfection risk
65
Why is it more likely to get recurrent / chronic sialadentis after 1st exposure?
Fibrosis from initial inflammation
66
Signs of chronic bacterial sialadentis
- Submandibular gland - Evolves of period of months - Inflammation gets progressively more fibroses - Strictures / calculi - Sjogren's syndrome - Intermittent pain, general aching / tenderness - Occasional pus secreted
67
How is chronic sialadentis managed?
Surgical removal of gland
68
What is Frey's syndrome?
Neurological disorder Damage to / near parotid glands Damage to autonomic nerves supplying skin sweat glands and SGs
69
Signs of Frey's syndrome
- Facial sweating - Facial flushing
70
Management for Frey's syndrome
Botox injections
71
What kind of SG developmental abnormalities can occur?
Atresia = total absence of SGs Hypoplasia = shrunken appearance of SGs
72
Are there are symptoms from SGs with developmental abnormalities?
Asymptomatic usually Other glands make up for reduced production from shrunken / missing SG
73
What usually goes with primary / secondary Sjogren's syndrome?
Systemic autioimmune condition E.g. Rheumatoid arthritis RA Systemic lupus erythematous SLE
74
What does Sjogren's syndrome affect?
Internal exocrine glands in pancreas, bowel, kidneys
75
Who is affected by SS?
Females 2% 15% of RA pts have secondary SS 30% of SLE pts have secondary SS
76
What can trigger SS?
Genetic predisposition Herpes virus Hep C
77
Systemic signs of Sjogren's syndrome
- General fatigue - severe and debilitating - Inflammatory vascular disease - Raynaud's syndrome - no blow flow to areas of body (causes it to appear white then blue) - Thyroiditis - Anaemia
78
What are some subjective symptoms of xerostomia in pts with SS?
- Nutritional deficiences - Difficulty swallowing / chewing - Sensitivity to spice - Salty bitter metallic taste - Burning mucosa - Lack of taste - SG swellings / pain - Cough - Altered saliva quality - Difficulty speaking, vocal disturbances - Lack of denture retention
79
What are some objective signs of SS related to oral cavity?
- Oral mucosa = dry, wrinkled, ulcerated, frothy saliva, lack of pooling of saliva in FoM - Tongue = dry, red, loss of papilla - Teeth = more caries, failed / fractured restorations - SGs = firm on palpation
80
How to differentiate between primary and secondary SS?
- Primary = dry mouth + eyes - Secondary = dry mouth + eyes + connective tissue disease
81
What is Sicca syndrome?
- Pts with dry mouth + eyes - But do not have SS - No other explanation for symptoms
82
How to manage Sjogren's syndrome
Palliative measures - Increase lubrication - Maintain OH - Immunomodulating agents - Pilocarpine - primary SS but side effects
83
What is Sialosis?
- Painless enlargement of major SGs - Bilateral and symmetrical - Soft to palpate - No xerostomia - No fever - No trismus - Uncommon
84
What is sialosis associated with?
Alcoholism Pregnancy Diabetes Anorexia Bulimia

CMS (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions